Preconception health for men: preparing to father a child

The testes are constantly making sperm, and the process is sensitive to temperature, toxins, hormones and general health. The NHS lists problems with sperm count, shape and movement, testicular damage from infection, injury or surgery, ejaculation disorders and low testosterone among the causes of male infertility. Many of these cannot be altered by lifestyle, but several can be influenced.

A planning mindset is also useful for the couple. Both partners checking their health before trying may avoid months of wondering, and it allows early referral if there are reasons for concern, such as a past testicular problem or cancer treatment.

The NHS low sperm count advice covers a handful of practical points. They are modest steps, and none guarantees a pregnancy, but together they stack the odds as far as is possible.

• Drink within the 14-unit weekly guideline and avoid binges.

• Stop smoking, including vaping where possible, and ask the NHS stop smoking service for support.

• Reduce excess weight if relevant; the NHS says losing excess weight may help improve sperm count.

• Wear loose-fitting underwear and avoid prolonged heat on the groin, such as laptops on the lap or very hot baths.

• Avoid recreational drugs.

• Limit exposure to pesticides, solvents and heavy metals at work, using protective equipment as advised by occupational health.

The NHS says anabolic steroids can reduce sperm production, cause infertility and shrink the testicles. Anyone who has used them and wants to have a child should speak to their GP, who can arrange hormone tests and semen analysis and refer on if needed.

Other medicines can also affect sperm. The NHS lists sulfasalazine, chemotherapy and some herbal remedies among them. Never stop a prescribed medicine without advice, but do tell the prescriber that you are planning a family so that alternatives can be considered. Treatments for hair loss, mood or testosterone replacement should be reviewed for the same reason.

Diabetes, thyroid disease, obesity, high blood pressure and sexual problems such as erectile dysfunction or ejaculation difficulties can all affect conception. The NHS notes that retrograde ejaculation can affect the ability to father a child and that sperm can be taken from urine or testicles in some cases for assisted conception. A man who has had undescended testicles, testicular surgery, mumps orchitis or a lump should mention it.

Sexually transmitted infections can reduce fertility in both partners, so a sexual health screen is sensible if there has been a new partner, and the NHS includes a chlamydia urine test among its male fertility tests.

The NHS advises seeing a GP if you have not conceived after a year of regular unprotected sex, or sooner if there are known concerns. Semen analysis is the first test and looks at sperm count and movement. A test can be arranged earlier for men with a risk factor, for instance previous cancer treatment, who prefer to know before trying.

Results are interpreted against reference values used by the laboratory, and a single abnormal result is usually repeated, since counts vary from sample to sample. Abnormal results lead to hormone tests, examination and sometimes referral to a urologist.

Trying to conceive can strain a couple, and men may feel reluctant to talk about worries or testing. Stress, poor sleep and low mood can reduce libido and sexual performance. Talking early, sharing appointments, and seeking counselling when trying becomes stressful all help. The NHS recommends seeing a GP if sexual difficulties or low mood persist.

Many supplements and gadgets are marketed to men at this stage. Evidence for most is limited, and some herbal products are listed by the NHS as potentially affecting fertility. Check with a pharmacist or GP before buying anything, and be wary of claims of a guaranteed rise in count.